Disclosure System

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REVIEW

Political Action Committee Registration

Committee Name *

Committee Type *

Traditional

Leadership

Caucus

Mailing Address

Address *

City *

State *

ZIP *

Phone Number *

Email Address *

Alternate Email Address 1 Optional

Alternate Email Address 2 Optional

Website Optional

Form of Organization *

Other Form of Organization Optional

Please describe your organization.

Date of Origin or Incorporation *

Campaign Account *

PACs may amend this information after registering. Account information will not be disclosed to the public.

Name of Account *

Financial Institution *

Mailing Address

Address *

City *

State *

ZIP *

Founding Organization (Optional)

If the PAC was formed by one or more pre-existing organizations, enter their names and addresses.

Name *

Mailing Address

Address *

City *

State *

ZIP *